Drug administration in nursing homes and residential centres for people with learning challenges, under chapter on Equality & Respect (added 03/06/2015)

PREFACE

One of the points made in the Preface to the book in support of the need for ethics is that official regulations to provide for standards, while necessary, are insufficient for best practice in social care. Ethical understanding provided through philosophy is also needed. Justin Welby, the Archbishop of Canterbury, who has a particular interest in business ethics, has emphasised this point in relation to regulations in banking. He was offering bankers a gap year to include the study of philosophical ethics. He told The Financial Times that “Regulation is necessary but not sufficient, it is very very far from sufficient. Culture [in banking] eats regulation for breakfast every time, we all know that, it’s a cliché.”

Ch. 1 INTRODUCTION

Ch. 2 WELL-BEING

Well-Being and the Natural Environment: Ethical Investments

Everybody’s well-being is affected by the state of the natural environment, whether from air pollution or increased exposure to extreme weather conditions. Business and industry are major contributors to environmental degradation, and some companies make a point of reducing the harmful environmental effects their operations can have. Investors in companies can also contribute to reducing environmental damage by choosing, for example, to invest in renewable energy companies instead of those which produce fossil fuels. This is part of what is known ethical investment. Another aspect of ethical investment is choosing only those companies which treat their workers with dignity and respect by providing them with safe and healthy working conditions and adequate remuneration. This includes not supporting companies with links to supply companies in poorer countries who exploit their workers.

Member of the Synod of The Church of Ireland Stephen Threw has said: “Ethical investors around the world, and now the Church of Ireland, have looked at the ethics and the risks and concluded that divestment from all fossil fuels is the right thing to do.” (Source: Irish Times 12 May 2018).

How is well-being achieved?

As we saw in this chapter, Aristotle understood happiness as well-being or flourishing. It enables us to live a good life in which we express our human nature through satisfying our natural desires managed by our thinking and reasoning. Our desires are not ends in themselves, but are a means to achieve an overall end, which is happiness or wellbeing. In caring for others, then, an essential element is not to smoother them with care, but, while providing them with practical assistance, to enable them to relate to their own feelings and desires and make their own best decisions.

Also, since we naturally find that family, friends, community and society are indispensable for our well-being, our own well-being is essentially bound up with the well-being of others. This means that in acting to satisfy our own needs and desires, we should take account of the needs and desires of others rather than simply look out for ourselves and our interests.

This has implications for politics and business in particular. It enables us to see that business and economics, for example, are not ends in themselves. Instead they are a means to an end, and this end is the social or common good.

In October 2007, a year before the collapse of the Irish banks, which was caused in large part by banks lending recklessly to property developers to increase their share of the property market and hence their profits, The Irish Times published a series of articles by Frank McDonald called ‘The Big Developers’. Developers he interviewed admitted the following as the motive driving them in their work:

Pure unadulterated greed to make a profit and become wealthy (with sometimes the projects ‘dressed up’ by calling them ‘world class’ or ‘a great contribution to the city’)

Vanity – ‘sometimes it’s the ego’

Status

Getting an adrenaline rush from competing and making deals.

In giving these reasons, strange as it may appear, the developers are not far from Aristotle’s thinking. For, they are accepting that business is about something else besides business, e.g. it’s about wealth, status, vanity. Profit is not the purpose of business. The purpose is what the profit gives you or what it brings with it. In other words, business is not an end in itself; it is a means to some end that is felt as desirable for happiness or well-being. The developers are accepting that business is for purpose of giving them a better life in the particular way they see it as better. To this extent, they are agreeing with Aristotle: business is about seeking happiness or well-being. This then leads to the question of what ultimately best provides for happiness. And Aristotle’s answer, as we have seen, is not material possessions, important as they are, but making good, that is to say, rational, decisions in managing our feelings and desires in accordance with our human nature, which includes our social nature as members of families and communities.

In his book It’s Good Business Robert Solomon makes the same point. He argues that profit-making in business is not an end in itself. Profit-making should be for the purpose of supplying people in society with the goods and services they need and desire at affordable prices. The following quotes are from his book:

There is no profit motive….. The motive is what money can bring: a decent standard of living, prestige, status, power i.e. the motive is what we consider money worth having for…; it is not an end in itself.

The nature of business might be profit, but the test of success is general prosperity and well-being.

Also, central to President Michael D. Higgins’s ethics initiative is promoting the rediscovery of an ethical core at the heart of business. Addressing the Institute of International and European Affairs in October 2014, the President made the point that the study of economic ideas and their spread into public discourse has become divorced from ethical ideas about the social good which economics should be trying to achieve. And this divorce has contributed to many people in Europe feeling alienated from society because they don’t benefit from the way economic growth is seen to be an end in itself: “It is my conviction that the current disjunction between economic theory and ethical reasoning is one that undermines our intellectual capacity to adequately address the ‘crisis of legitimation’.”

Note: this material is also relevant for Chapter 7 ‘Greatest Happiness Principle’, which includes a section examining the Irish banking crisis and its consequences of austerity and cutbacks in social services. It is also relevant for Chapter 9 ‘Social Well-Being’ on the role which the practice of virtues has in providing for the common good.

Ch. 3 EQUALITY AND RESPECT

Assisted Decision-Making for People with Mental Incapacity

We have seen how, for Kant, the recognition that each person has his/her own will and reasoning ability is central to their identity. It also underpins the idea of their moral autonomy in directing their own life in accordance with universal principles. We saw, too, that one practical consequence of this understanding for social care is that care workers should support people in making their own informed decisions about the kind of care they want or prefer. We saw, also, that difficulties in practice arise when people have reduced mental capacity to make their own decisions. For example, some people may have an intellectual disability; others may have diminished capacity to think for themselves in old age when they have dementia; and others again may have suffered a brain injury. On Kant’s basis, we saw that the ethical approach is to continue to support them in their own decision-making insofar as possible.

On p. 54 in the section ‘Kant’s Ethics and Social Care’ the government’s Assisted Decision (Capacity) Bill is mentioned. It will give legal status to the appropriate ethical approach to caring for people with reduced capacity. It lays down the requirement for a new person-centred approach. In particular, it provides for the establishment of a Decision Support Service along with new positions of decision-making assistant, co-decision maker, and decision-making representative.

For people who will be working in these roles, the focus is to try to establish the wishes and preferences of individuals. In relation to a specific issue, they will be required to determine insofar as possible if they have the capacity to decide for themselves and, if in need of assistance, what is the level and type of assistance which should be given to help them decide in line with their wishes.

In effect, instead of the old paternalistic approach of deciding for other people what is thought to be in their best interests, the Bill presumes that people have a capacity to make their own decisions unless there is clear evidence that they lack this capacity to an identifiable degree. They will then be given decision-making support in line with the kind of decision they would have been likely to make unaided if they had not lacked that capacity.

Also, the new law will give statutory recognition to the ethical position that people who have capacity are entitled to determine and register in advance the kind of medical and social care they would like to receive were they to suffer a loss of capacity. This will give legal status to the position at present on end of life care where people can make an advance directive about the care they would like to receive. This is mentioned in the section ‘Social Policy Aim’ on end of life care on pp. 237-8.

(Source: See ‘Proposed Capacity Bill is enlightened, but just a start’, Patricia Rickard-Clarke, Law Matters in Business this Week, The Irish Times 23/10/2015)

Equality

In voting approval in a referendum on 22/05/2015 to change the section in the constitution on the family to allow for marriage to be contracted between two people regardless of their sex, a majority of Irish people extended to right to marry to people with a same sex orientation. By doing this they were voting for them to have equality with heterosexual couples.

Respect

As we saw in this chapter, a basis for the principles of equality and respect lies in the understanding in Kant’s theory of each person having their own autonomy and a rational capacity, and that these capacities are central to understanding a person as an individual and for the requirement to have the greatest of respect for them, however much their capacities may be impaired by dementia, learning difficulty or other conditions. Findings in Carl O’ Brien’s investigative reports into nursing homes for the elderly and residential centres for people with learning difficulties revealed that drugs are being administered to some people to control their behaviour when it is seen as challenging, and that in some cases the type of drug used is having harmful side effects. The report also found that in some cases drugs were being used as a convenient way of pacifying residents, rather than spending time engaging with them and addressing their needs by other means.

As we saw in the chapter, the principle of respect for autonomy means that a person’s informed consent for the care proposed for them should always be obtained from them insofar as possible, and this applies in particular for any drug administered to them. However limited the extent is to which they are capable of making an informed decision, the principle requires that it should always be sought and taken into account. And where necessary, other people, such as next of kin, can assist a person in making their decision, which should always be with the aim of preserving and developing their autonomy to the greatest extent possible in providing them the kind of care that is in their best interests.

(Sources: Carl O’ Brien “Vulnerable elderly people given ‘chemical cosh’ drugs’ and ‘Bitter pills: nursing home residents are being endangered through misuse of medication’ The Irish Times 01/06/2015. And Carl O’ Brien ‘Chemical restraint of intellectually disabled common in residential centres, study finds’, The Irish Times 02/06/2015.)

Ch. 4 CARE

French Lesson in Caring for the Elderly

In this chapter we have seen that care ethics should be focussed on the individual needs, desires and choices of the people who are being cared for. Policy in Ireland is directed towards facilitating elderly people who need care to be cared for in their own homes insofar as possible where that is their preferred option. At the same time, many elderly people in Ireland are cared for in retirement homes, and it is remains very much part of care practice.

In France a recent report, Ethical Stakes of Ageing, by the government’s National Consultant Committee on Ethics, whose members are doctors, lawyers, scientists and philosophers, referred to the ‘ghettoisation” of the elderly in retirement homes. The report found that this was the result of ageism, collective denial and inadequate and disrespectful policies. In France nearly 600,000 elderly people live in 7, 200 retirement homes. The report found that the institutionalisation of the the elderly may be based on good intentions, “but the frequent absence of alternatives and being forced to pay for something they do not want is contrary to ethics and respect for these persons”. (The cost of living in a retirement home is 114% of the average monthly financial means of the elderly person).

The report called for more help to be give to family members to enable them to care for elderly relatives. It also called for better pay and training for social care workers so that elderly people can have the option of living in their own homes while receiving the care they need.

The report also points out that attitudes in society towards the elderly have changed. No longer is old age seen as a sign of wisdom and detachment. Instead, is is seen as something shameful to be kept hidden. “Millions of elderly people are ignored in social discourse and by the media. This is attributed to an obsession with youth and “a shared modern fear of ageing.” Quoting the philosopher Simone de Beauvoir, the report said that in the 20th century, the status and value of old age “diminished a great deal because the notion of experience was discredited”.

The report also compares the segregation that results from ageism with racism. “The apartheid of age is all the more fierce because it is unconscious, including among the victims.” And this has depressive effects on the elderly. 40% of residents in France’s retirement homes are said to suffer from depression, and France has one of the highest rates of suicide in Europe for people over 75.

There report also called for new ways to incorporate residential homes in society to be explored, including locating them in apartment buildings, and promoting self-management of the homes by the elderly themselves. (Source: Laura Marlowe “Elderly in France are excluded, ‘ghettoised’ and in fear of social isolation’, The Irish Times 19 May 2018).

Use of Human-Like Robot Assistants in Meeting Care Needs

Human-like computer robots are already in use in meeting care needs, and will be used increasingly in the future. They will also become more sophisticated, capable of performing a number of tasks that, up-to-recently, would have to be done by a social care worker, or not at all. To give one example, researches at Trinity College Dublin have built a prototype robot “designed to attend to older people’s social care needs”. It is known as ‘Stevie”. Stevie has a degree of movement and can engage a person in some light conversation. It can remind people when they need to wake up, or take medication. It’s screen also facilitates a video call with relatives or professional services. It can provide pictorial prompters for those with hearing impairments.

At the demonstration launch of Stevie, project leader Professor Conor McGinn said: “Stevie can perform several routine tasks which will improve efficiency and substantially alleviate pressure on care staff during periods when the facility may be understaffed. The social interaction that is possible with the robot brings many benefits. It provides a compelling way to reduce boredom and stimulate mental activity. It can have basic conversations with its users and play a series of simple games.”

Research in developing such a device is only at the beginning. In the future it is expected they will be able to do a lot more, including offering physical assistance with tasks.

From the state’s point of view, robot care is likely to prove cost-effective in providing some care services, but does that justify using them? Their use raises a number of ethical questions. Will the use of human-like machine-programmed robots, in place of a care worker, adequately respect the individuality and humanity of the person being cared for. Will the unreality of the machine-care contribute to service users feeling cut off from their fellow humans and lead to isolation and depression? Will people be allowed make an informed choice about whether they would like to have a robot care for them in preference to the service of a care worker? Should their use be limited? If so, to what degree and why?These are just some of the questions raised by using robot care in residential centres, nursing homes and people’s own homes.

It is important that all involved in, and concerned about, developments in robot care engage in public debate about these and other ethical questions. (Sources and further reading: See ‘Trinity’s Stevie the robot offers older people help and a little light conversation’, Irish Times 14/11/2017. ‘How automations are infiltrating the family’, Irish Times 11/5/2017. Meet the Replicants, Manus Charleton, Dublin Review of Books, issue 94 Nov. 2017. Note all sources available online).

People in their thousands have been fleeing to Europe to escape the ravages of war, in Syria and Eritrea in particular. Large numbers have been trying to cross the Mediterranean from North Africa packed into unseaworthy boats by smugglers who they have paid to bring them across. Some boats have capsized and many have drowned, including women and children, about 1,750 in the spring of 2015 while attempting to cross from Libya. Others have been rescued and taken to ports in Italy and elsewhere. Irish naval vessels, along with those of other countries, have been participating in rescue operations. Many more thousands of displaced people who have fled the war zones are living in camps. There are close to two million in camps on the Turkish side of the Syrian border.

European values – the values which underpin the European Union – include the values of freedom to pursue wellbeing, equality of treatment and a duty of care. As we saw in the chapters which explore the philosophical basis for these values, the values relate to how everyone should be treated. They don’t just refer to how Europeans should treat each other. Re-settling in Europe large numbers of people has practical implications for the economies, welfare systems and societies of European countries. It is a major political and social international issue that is likely to last for a long time. Yet, how well or badly the European Union responds to the continuing humanitarian crisis is central to the moral identity of its peoples.

As we saw in the Chapter on Care, for care to become an operative value, it’s important to see people in need as individual people: mothers, fathers, sisters, brothers and not simply as a depersonalised group under headings such as refugees or migrants. And on pp. 70-73 we looked at the bodily basis for care. We are moved to care for others from seeing with our eyes and hearing with our ears, in news reports and elsewhere, the suffering and risks to health and life that others are going through. Our bodies keep us open to the disposition to care, which indicates the importance of not averting our eyes.

In the Introduction to Chapter on Empathy (on pp. 90-92), we saw also how important imagination is in understanding what empathy involves, especially in empathising with those who are distant from us. It is important to be able to imagine for ourselves what it is like for people to be undergoing risks to their lives and wellbeing if we are to be moved to assist them.

(Sources and further reading: ‘Before dangerous journey towards idealised Italy, migrants must survive risks of Libya’, David D Kirkpatrick, The Irish Times 30/04/2015; ‘Us and Them: the two faces of today’s migration’, Fintan O’Toole, The Irish Times 27/06/2015.)

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Case Study 4.1: Treatment of Billy

Consider and discuss this case study on pages 84-5 in light of your understanding of what care philosophers have said about care as a value and the value practices which follow from it in how we should relate to others.

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Questions to Consider and Discuss

From your study of why care is a core ethical value, consider and discuss the following two statements. In considering the second statement, do you think the same could be said for social care, as for healthcare:

1. “The President said society needed to move on beyond the phrase ‘disability’ and talking about getting through the barriers, to full participation in society through the life cycle” (Source: ‘Care of ill not market commodity, says Higgins, Paul Cullen Health Correspondent Irish Times 22/05/2014).

2. “There is too much emphasis on the technical aspects of providing healthcare and not enough to modernise the focus around ‘the humanity, the dignity, communication and empathy with the patient'” (Source: Tracey Cooper, outgoing Chief Executive of Hiqa in ‘Good practice and appalling practice’ in health service, says outgoing Hiqa chief’, Paul Cullen interview Irish Times 26/05/2014).

Ch. 5 EMPATHY

In this chapter we looked at empathy as a natural ethical feeling or emotion. We also looked at the view, which some philosophers have, that we may not have free will; that our actions are determined for us by prior causes of which we are unaware. One reason for arguing that we lack free will, is to see our moral response, our sense of right and wrong, as having its source in our evolutionary development.

In looking at virtue theory in Ch. 2, we saw that rational capacity is not unique to humans, and hence not the defining element in human nature. Other primates have been shown to be able to exercise rational capacity, and also to have an innate sense of morality, in particular for unfairness and fairness.

A recent further study, published in Scientific American, supports the existence of a moral sense of fairness in female capuchin monkeys.

Pairs of the monkeys were given pebbles which they could trade for a treat, such as a slice of cucumber. When one monkey in a pair was given a preferable treat, a grape, in exchange for her pebble, the other monkey became upset and refused to accept her lesser treat of cucumber, even throwing it back.

This exhibition of a sense of unfairness also occurred among monkeys who had to watch other monkeys receive a grape without having to hand over a pebble.

This evidence of other primates having a moral sense supports the neurobiology view of morality, which is explained in this chapter. On the neurobiology view, we get our sense of morality from our genetic inheritance through evolution. It would have arisen as a means which helped primates and early humans adapt to their environment and to each other in order to survive. And to this day, our sense of right and wrong is still embedded in our neural pathways in the brain where it is triggered by our perception of some unfairness or fairness beforewe become aware of it as a thought.

In this chapter, we looked at this evidence of a lack of conscious control over our behaviour, or lack of free will, as one reason, among others, for why we should have empathy for others, especially for those who come to behave in ways that are not good for them.

(Source: ‘Why you should never short-change a monkey’, William Reville, Irish Times 21 May 2015)

Ch. 6 HUMAN RIGHTS

Child Poverty Dooms Children for Life

Professor Jeffrey Sachs, special adviser to the UN secretary general, said failure to invest in children “dooms them for life”. He said “Brains are really fragile instruments. They are not robust. When a child grows up in an environment of stress and their cortizol system is triggering all the time – that rewires the brain. We know that the consequences of that are devastating, for physical health and cognitive development, for a lifetime.”

He went on to say that how resources are distributed in a market economy is “a choice. A market system produces wealth but it does not produce social justice …. The basic problem of the market economy is that it is based on unleashing greed and the desire for wealth. It has to be tempered by the demands of morality, ethics.”

Catherine Zappone, Minister for Children, said one in every ten children are living in consistent poverty, which is experiencing both income poverty and deprivation. She said “These figures are hard to ignore. Indeed to do so is to fail in our moral and ethical duties to these children, and their futures.”

(Source: ‘Spending urged to tackle child poverty’, Kitty Holland, Social Affairs Correspondent for The Irish Times reporting on “a high level” conference on child poverty 10/11/2018).

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Support for Human Rights under Threat

In an address to the Institute of European and International Affairs entitled ‘Is Europe Facing a Human Rights Crisis?’ Professor Michael O’Flaherty, the Head of the European Agency on Fundamental Rights, said he found it alarming that people devoted to building good societies were no longer committed to human rights. Since the 1948 UN Universal Declaration of Human Rights, support for human rights has been “an astonishing success story” in helping to provide for the good. However, he believed there was now evidence of some loss of public and political support for ensuring that societies were based on providing people with their fundamental right to have a decent and dignified life. He instanced the inadequate response of the European Union to providing facilities for migrants to a standard in accordance with their human rights, many of whom are families who have come to Europe to escape being killed in wars, including vulnerable children without parents. He also said that in Europe there were also rising levels of inequality as well as hate crimes and hate speech. (Source: ‘Foundations of human rights are under attach, says leading lawyer’, Colm Kenna, Legal Affairs Correspondent, Irish Times 25/10/2016).

Protest Against Ireland’s Failure to Ratify UN Convention on the Rights of Persons with Disabilities

People from up to 100 disability support groups protested outside the Dail on 30 March 2017 against the Government’s failure to ratify the UN Convention on the Rights of People with Disabilities ten years after it had committed to ratify it. Protesters were told that the Ireland is now the only EU country which has yet to ratify the treaty. Disability rights campaigner Joanne O’Riordan told the rally that “I and 600,000 other people living in Ireland with a disability refuse to be pushed to the background. I have hopes, dreams and aspirations like everyone else. I want to be a contributor and participate in every way.” She called on the government to “do the right thing”. (Source: ‘Ireland “living a lie” over failure on disability rights’, Hugh Lineman, Irish Times 31 March 2017).

Rights Agreement for People with Disabilities

Catalina Aguilar, UN special rapporteur on the rights of persons with disabilities, said it would be a “pity” if Ireland was “the last European country” to ratify the UN Convention on the Rights of Persons with Disabilities. Only one other country, Finland, has yet to ratify it and is expected to do so shortly. Countries who sign the agreement guarantee to “protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities and to promote respect for their inherent dignity.”

Ms Aguilar pointed out that the convention guarantees rights rather than treatment and that it “challenged centuries of discrimination, exclusion and marginalisation” and ways of thinking about people with disabilities that were “deeply embedded in our cultures”.

Eddie Redmond, chief executive of the Irish Deaf Society said sign language was still not recognised in Irish schools.

Adrian Noonan, a self-advocate with Inclusion Ireland said continued criminalisation of sex with an adult with an intellectual disability made people with a disability “afraid to have this type of relationship”.

The government have promised to ratify the convention within six months. (Source: ‘McGrath says UN convention on disabilities will be ratified’, Irish Times 10/05/2016).

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Children at Risk: Resources for Investigation and Prevention

In this chapter there is a case study to consider and discuss the human rights justification for the State to do more to protect children (See Case Study 6. 2 ‘Young, Vulnerable and at Risk, p. 128). As a result of recent cases, there is increasing concern that children who are at risk of neglect and abuse are not being identified by social services. And even when they are identified as at risk, or as having experienced neglect or abuse, there is concern that adequate measures are not being taken to protect them. Tulsa, the State’s Child and Family Protection Agency, is currently carrying out a review of the circumstances which led to children who experienced neglect and abuse being left with their mother for five years. Lack of investment in child protection services is seen as a major factor. Tulsa are reported to be struggling to cope with the number of referrals they receive. The number of reports of cases of suspected abuse, neglect or welfare concerns which have not yet been allocated a social worker is said to be in the thousands, and some are considered to be high priority. The State still needs to allocate the level of funding and staffing needed to ensure the safety and welfare of children is protected. (Source: ‘Children remain at risk despite series of reports’, Carl O’Brien Irish Times 13/04/2016).

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Change in Irish Law Bans Physical Punishment of Children

In this chapter we looked at the main philosophical sources for human rights, and how theses sources have informed rights which are given legal status in international human rights agreements and in national laws. Personal freedom is high among the rights which people have, and includes a right to bodily integrity whereby we are not subjected to physical harm. These rights have a basis in moral philosophy, in natural law theory for example, which gives people a right to self-preservation, and under essential interests theory which specifies a right to development. Also, under Locke’s theory people have a right to personal freedom. However, children have not been regarded as having rights to personal rights to the same extent as adults. For example, they did not have the right to be free of physical punishment from their parents, even thought in law children have a basic right to protection and care.

A ban on physical punishment of children is now set to become law in Ireland. Up to now, while The Children’s Act (2001) warned against the excessive use of force against children, the law has allowed parents and carers to punish children physically in certain circumstances. But as part of the Children First Bill, currently going through the Oireachtas to become law, a legal provision which had allowed for “reasonable chastisement” of children has been removed. This effectively makes it illegal for anyone to hit a child.

Hitting children violates their human rights under the United Nations Convention on the Rights of the Child. And in 2006 the UN informed the Irish government that it was “deeply concerned that corporal punishment within the family is still not prohibited by law”. And in May 2014 the Council of Europe ruled that the absence of a clear ban on smacking children in Ireland violated their rights. The Children’s Rights Alliance has also been urging the government to “outlaw violence against children” and to do more to support positive parenting.

It has taken many decades to grant to children their right in law not to suffer physical punishment. In 1967 a Doctor Cyril Daily began a campaign to end corporal punishment of children in all schools. His campaign was opposed by among others the primary schools teachers union and was not supported by the Catholic Church in Catholic schools. It wasn’t until 1982 that corporal punishment was banned in Irish schools.

Currently, 46 countries have a complete ban on physically punishing children, and this includes 20 of the 28 EU member states.

(Source: ‘Dail vote a fitting legacy for late doctor’s fight to protect children’, Patsy McGarry, The Irish Times 14/11/2015).

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Direct Provision Accommodation for Asylum Seekers

The following is further background for Exercise 6.2:

The government is to set up a working group in September 2014 to review the direct provision system for asylum seekers. This follows criticism by human rights groups and others of conditions under which people have to live for long periods while awaiting a decision on their application (See Carl O’Brien ‘Asylum seeker provision to be reviewed’, Irish Times (12/08/2014). (See also ‘A cruel and shameful system’, Irish Times editorial 25/07/2014, and Carl O’Brien’s series of articles ‘Lives in Limbo’ beginning in the Weekend Review 09/08/2014 and available online).

Ch. 7 GREATEST HAPPINESS PRINCIPLE

President on Morality’s Role in Shaping Society

At the launch of his report, The Importance of Ethics, The President of Ireland’s Ethics Initiative, President Michael D Higgins described the events which led to the 2008 recession as “great failures of an ethical kind, which included “a number of breaches of trust.” He said there had been “great failures in professions that had the privilege of being self-regulating ….”

He also said it was important to identify and learn from the assumptions which prevailed during the boom period about the kind of society it was providing, with a view to creating a better alternative. “The good news is that the public want to get to a better place.” (‘Higgins criticises ECB’s Treatment of Ireland’, Patsy McGarry, Irish Times 2 February 2016).

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The Housing Crisis as a Moral Issue

The number of people without a home of their own has been increasing in Ireland in 2015. The Minister for the Environment, who has responsibility for ensuring all citizens have adequate housing, either in the rented sector or through social housing, said that the scale of rent increases sought by some landlords is a “moral issue.” He said he had “huge concerns regarding the levels of some rent increases”. The increases were contributing to the number of people, including families, being made homeless and having to live in emergency accommodation. And he said the problem had reached a stage where he would agree that it is now a “humanitarian crisis.” Data supplied by the Dublin Region Homeless Executive shows that in August 2015 1, 275 children in 607 families were in emergency accommodation in Dublin compared with 640 in 294 families the year before. In its annual report Dublin Simon Community said interventions over the last year by government to try to solve the problem had “no impact.”

Note: This issue is also relevant for consideration and discussion on the basis of understanding of other values and principles in other chapters, in particular the chapter on human rights.

In this Chapter we looked at the ways in which poverty is measured and also at its personal and social effects. We saw too how the greatest happiness principle supports doing more to help people in poverty. Taoiseach Enda Kenny has said that it is morally unacceptable that families in households with a person in full-time unemployment should be poor. The following is a report of what he said:

‘He said work should always pay more than welfare, and no household with a person in full-time employment should be poor, but this was not always the case.

Mr Kenny said the most recent data from 2013 showed that families where the head of the household was at work accounted for almost 9% of those classified as being “consistently poor” – a definition that comprises measures of both income and material deprivation. “That is morally unacceptable and economically unwise”, he said.’ (Source: ‘Worker poverty ‘morally unacceptable’, Martin Wall, Industry Correspondent, The Irish Times 27/02/2015)

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Homeless Families

In this chapter we looked at the issue of poverty in Ireland and how justification for doing more to tackle poverty can be found in the greatest happiness principle. Currently (April/May 2014) there is public concern about the plight of families who become homeless. There has been media coverage of a mother and her three children who had to spend eight nights living in a car. The Irish Times has reported that the Dublin Region Homeless Executive accept that the number of families presenting for emergency accommodation, which is provided for them in a hostel or hotel, is on the increase and that it’s not always possible to provide accommodation to avoid people having to sleep rough (See ‘Emergency hotel bill for homeless to hit €4.5m’, and ‘I tried to make like an adventure for the kids’ Irish Times 05/05/2014).

Consider and discuss this issue in light of your understanding the greatest happiness principle and what it obliges us as a society to do for who experience hardship and misery.

Also, drawing from your understanding of human rights in Chapter 6, consider and discuss the issue from the point of view that having adequate accommodation is both a moral and legal right.

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Children in Poverty

In this chapter we looked at an ethical theory which supports reducing poverty, and in particular poverty affecting children, on the basis that policies to provide for the greatest happiness of the greatest number of people are justified by the greatest happiness principle. An October 2014 Unicef report ranked Ireland 37th of 41 OECD countries for its level of child poverty. Eighteen countries saw a reduction in child poverty since 2008 and 23 an increase, with Ireland among the worst affected countries since the recession began in 2008, with the number of children in poor households increasing by 130,000. An Irish Times editorial commented as follows:

“Of all social wrongs, a denial of opportunity to children is the most insidious. Young people bear the brunt of this exclusion but society also pays because of their reduced skills and productivity and an increased dependency by victims on health and social services. On an ethical level, children have just one opportunity to develop their potential and the denial of that opportunity diminishes us all. Childhood poverty and a lack of special early education and health programmes have consistently blighted young lives.”

(‘Failing our children’ Irish Times editorial 30/10/2014. See also Colin Gleeson, “‘Decade of progress lost’ as children bear the brunt of recession”, The Irish Times 29/10/2014)

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Bank of Ireland Acknowledges Moral Debt Owed to Irish People

Bank of Ireland Chief Executive, Richie Boucher, acknowledged that the bank owed a moral debt to the Irish people for the burden it placed on them when it got into debt and needed billions from the government to prevent it from collapsing. He told the Oireachtas Banking Inquiry: “We can never fully repay in moral terms, we’ve tried to do it in financial terms.” (Source ‘This Week They Said, The Irish Times 09/05/2015).

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Professor Patrick Honohan on Ethical Responsibility in the Banks

This chapter includes an ethical evaluation of practices which contributed to the banking crisis, a crisis which had knock on effects of austerity and cutbacks in social services. On 15/01/2015 Professor Honohan (Governor of the Central Bank) made a presentation to the Oireachtas Joint Committee of Inquiry into the banking crisis and answered questions. Asked by Deputy Michael McGrath (Fianna Fail) if it was his view that ‘in an important sense the major responsibility lies with the directors and senior management of the banks that got into trouble’, Professor Honohan replied as follows:

‘It is my view. Sometimes in discussions with people they might ask if I am entitled to have that view and if it is not just my personal view of the ethics of banking. I do not think banking and finance can work without a high ethical standard, a standard that tells top bankers that they have a heavy responsibility here, that this is not money they are being given to gamble with but money they are being given which forms the basis of a huge underpinning of the economy and society. Regarding developers, they probably think that the banks did give them the money to gamble with – it is a different environment. I think there is a heavy responsibility, but perhaps it is more an ethical than a legal concept.’

Ch. 8 DIVERSITY

Valuing Different Perspectives on Past Events

In this chapter we looked at the philosophical reasons why moral values differ among people within different cultures and within the same culture; why there is moral pluralism or diversity. We also saw that the philosophical reasons support why we should respect the values of others, but also why there are limits to accepting as justified all the values that people hold. For example, we are not required to accept a practice which some people value when it conflicts with basic human rights.

An aspect of moral diversity is accepting the different ways in which people value their memories of historical events, such as the 1916 Rising , the War for Irish Independence and the First Word War. Writing about the ethics of remembrance President Michael D. Higgins has referred to a way of remembering “that does not serve to form exclusive judgements or reinforce grievances, but, rather, to embrace the stories, the memories and the pains of the other.” He calls this disposition “narrative hospitality”. It is characterised by “an openness to the perspectives of the other carved out at the very heart of public comparative discourse.” (Source: ‘Openness to perspectives of others must be at heart of remembering’, President Michael D. Higgins, Irish Times 01/07/2016).

Ch. 9 SOCIAL WELL-BEING

In this chapter we saw that MacIntyre made the point that organisations of their nature can present their members with a challenge to behave with virtue or character qualities, such as honesty, responsibility and accountability. For example, it may lead some people to deny or cover up information to protect the organisation’s reputation or to protect their colleagues. One way in which this pressure might present itself is in terms of a conflict to behave with either loyalty or honesty. And loyalty is misguided when it’s prized above honesty. An Irish Times editorial made a similar point when it commented: ‘Valuing loyalty above duty leads to elitism and rots the fabric of democracy’ (Editorial 07/03/ 2014). For an article examining the effect on Irish society of prizing misguided loyalty over honesty or duty see Fintan O’Toole’s article, The Irish Times Weekend Review 29/ 03/ 2014).

Ch. 10 SOCIAL CONTRACT ETHICS

Ch. 11 SOCIAL JUSTICE

Wealth Inequality and Policy Decisions

In its latest international report, Oxfam have found that the world’s 62 wealthiest people now own the same amount of wealthy as the poorest half of the global population. It estimates that the richest 1% of the world’s 7.3 billion people now own as much as the rest. The report states that “The gap between rich and poor is reaching new extremes.” Jim Clarken of Oxfam Ireland said “The current system did not come about by accident. It is the result of deliberate policy choices.” (Source: ‘Oxfam says 1% own half of the world’s wealth’, Suzanne Lynch, Irish Times 18/01/2016).

Income Inequality

In this chapter we looked at some of the theories which attempt to explain what social justice means. We saw that both Aristotle’s theory of balance, and Rawls’s theory of fairness, give rise to the view that social justice means people should be relatively close to each other in the income and standard of living which they enjoy. They argued that big gaps are not justified. In January 2014, Oxfam produced a report Working for the few . It gives the statistic that the combined wealth of the 85 richest people in the world amounts to €1.2 trillion, and that this is the amount which the poorest half of the world’s population (3.5 billion people) have to live on. Oxfam’s chief executive, Winnie Byanyima, is reported as saying “It is staggering that, in the 21st century, half the world’s population – that’s 3 and a half billion – own no more than a tiny elite whose members could all fit comfortably on a double decker bus. We cannot hope to win the fight against poverty without tackling inequality” (‘Oxfam warns of ‘power grab’ by wealthy Irish Times 21/01/2014).

In its editorial on the report The Irish Times said “Growing inequality is a critical moral, economic and political challenge. Rightly or wrongly, it feeds a sense of unfairness, of burdens unequally shared, and perceptions that, although a democracy, our society is run by and for the few. Yes, it is the challenge of our time.” (Editorial Irish Times 27/01/2014).

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Inequality of Educational Opportunity

A study by the Economic and Social Research Institute (ERSI) in 2014 show that a person’s chances of going on to third level education depends on his or her family’s economic and social circumstances. It found that “young people from working-class backgrounds were less likely than their middle class peers to go on to higher education.”

The study also found that “young people who attended social mixed schools and, even more strikingly, middle-class schools, were more likely than those from working-class schools to go onto to some form of post-school education and training.” (ERSI report: Leaving School in Ireland: A Longitudinal Study of Post-School Transitions. See also Jacky Jones Ireland’s educational caste system affects all aspects of life, The Irish Times Health + Family, 02/09/2014)

Ch. 12 ABORTION, EUTANASIA AND ASSISTED SUICIDE

In its judgment on 09/06/2016 the UN committee agreed with a woman who claimed her human rights rights were violated in not being allowed to have a safe and legal abortion in Ireland in circumstances where she was carrying a foetus diagnosed with a fatal foetal abnormality. The woman went to England to have an abortion, and the committee judged her rights were violated under the provision in the International Covenant on Civil and Political Rights on a number of grounds: that no one should have to suffer inhuman and degrading treatment (article 7), that she has a right to privacy (article 17) and equality before the law (article 26). The committee criticised the government for not providing the woman with her rights. It said she “was forced to choose between continuing her non-viable pregnancy or travelling to another country while carrying a dying foetus, at personal expense and separated from the sport of her family, and to return while not fully recovered.” In its submission to the committee the government said that the right in the Irish constitution of the unborn to life together with the right to life of the mother represented “the profound moral choice of the Irish people”, and that there was a right to travel to other countries for services legally available there. The committees view are not legally binding.

The government is to set up a citizens assembly to examine Irish abortion law and report on any need for change. See this chapter for background to the legal position along with with arguments for three basic ethical positions which people take on the abortion question.

The acquittal on 28 April 2015 of Gail O’Rourke on charges of assisting in the suicide of her friend who was in a late stage of MS has focussed attention on the need which some people feel for a change in the law to allow for assisted suicide in certain circumstances. For further information on the case and on the issues see the following:

‘TD to bring assisted suicide Bill before Dail’, Sarah Bardon, Political Reporter, The Irish Times 30/04/2015.

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Abortion and Human Rights Committee Report

The chapter gives some background on the abortion issue in Ireland, along with the main ethical considerations which inform three different viewpoints: conservative, liberal and intermediary. A United Nations Committee report (published July 2014) provides further background material. The Committee examined Ireland’s record in providing for human rights under the International Covenant on Civil and Political Rights. The Committee found that women in Ireland have a right to an abortion in cases of pregnancy as a result of rape and incest, and in circumstances where the foetus has fatal foetal abnormalities. It also noted there is a right of access to an abortion service where a woman’s health is at serious risk.

The Committee’s findings are not legally enforceable. They are offered to governments as guidance in meeting their human rights obligations under UN international agreements. To address its findings, the Committee called on the Irish government to revise its Protection of Human Life in Pregnancy law, and also to revise the Article in the constitution which guarantees right to life of the unborn with due regard to the equal right to life of the mother.